What is an en bloc capsulectomy?
En Bloc (in a block or a whole piece) capsulectomy refers to the removal of the breast implant and the scar tissue, or capsule, that has formed around it as a singular block of tissue.
Why do patients request an en-bloc capsulectomy?
Most commonly patients seek an en bloc capsulectomy because of concerns that the implant is causing them health problems. These symptoms come under the general term of breast implant illness. This term is used widely among patients and advocates, however, the medical literature has seen other names such as human adjuvant disease or autoimmune syndrome induced by adjuvants (ASIA).
What is the difference between an en bloc capsulectomy, a total capsulectomy, a sub-total capsulectomy and a partial capsulectomy?
- An en bloc capsulectomy removes all the scar tissue (capsule) with the implant still completely within it as one unit. The implant and its contents are not exposed to the patient and any silicone within the scar is removed by this process.
- A total capsulectomy removes all the scar tissue, but this does not specify if the implant is first removed by opening the scar capsule potentially “spilling” silicone into the operative field. In essence, the implant is first removed and then the scar capsule is subsequently removed from the body.
- A sub-total or partial capsulectomy describes first the separate removal of the implant and then an incomplete removal of the scar capsule to some degree. This is a common practice for revisional surgery where the capsule is not thick or problematic.
The en bloc capsulectomy is a 2-3 hr procedure undertaken at a major hospital under general anaesthesia. The approach is most commonly through an existing scar under the breast. The only difference being that the length of the incision is often longer than that used for primary breast augmentation.
The procedure is quite involved and depending on the plane of the implant and the degree of scarring, the en bloc capsulectomy can pose challenges to a surgeon attempting to remove it cleanly. Classically the scar capsule attached to any muscle or on the chest wall adjacent to the convexity of the rib cage can be particularly challenging to remove.
Dr Lam will take great care in removing every sign of implant and implant capsule in one piece.
What happens if all of the capsule cannot be removed?
In all but very few cases, all of the capsule can be removed, however if there are particularly difficult areas such as on the surface of the curved sections of ribs or under the muscle, then Dr Lam will ablate these areas by first curetting or abrading and then he will use diathermy to ensure no cells or residual scar is left. Even still these small patches often represent a very small patches.
In all cases, the pocket is washed with copious amounts of saline.
What testing of the implant does Dr Lam do?
The routine tests which are performed include
- Microscopy and culture – to test for organisms
- Histopathology – to analyse the capsules under the microscope for silicone or signs of cancer. CD30 is a cell marker for anaplastic large cell lymphoma (ALCL) and this is tested for
- Peri-prosthetic fluid- If there is fluid around the implant, this is tested for microscopy, culture and CD30 as well
What is the recovery like?
Recovery is surprisingly well tolerated with mild to moderate discomfort that is well-controlled with basic analgesia. Drains play an important part of the post-operative care and may remain in place for as long as 7 -9 days. Hospital stay is also variable, but most patients choose to stay for 2-3 days.
You may be discharged home with drains in place, in which case, you will have guidance on the management of these drains and then see Dr Lam at Cranford House to have the drains removed at your 1 week post surgery appointment.
Will Dr Lam take intra-operative photos to show me the implants and the capsules removed?
Yes, Dr Lam will take photos of the implants with the capsule intact and separated from each other.
Can I have my implants back to take home?
Yes, If you prefer, you can take them home. In the event that you no longer want your implants, you can return them to Cranford House Plastic Surgery and we will dispose of them appropriately.
En Bloc Capsulectomy with Dr Quoc Lam
Dr Lam has attained a reputation for achieving high-quality results, while practising in a safe and considered manner. He is well-liked by his patients because he listens and takes great care in surgery and in his post-operative management. Dr Lam has a warm and kind manner. His consultations are relaxed, informative and respectful. He will take the time to understand your situation and goals.
Dr Lam is accredited at most of the hospitals in Adelaide, but regularly operates out of Burnside Hospital, St Andrews Hospital and the Stirling District Hospital.
Dr Lam has trained over many years to acquire a wide range of reconstructive and cosmetic surgical skills that allow him to combine aesthetics with reconstruction, while having the confidence and depth of experience to deal with more complex problems.